Meeting Today’s Nurse Leadership Challenges

By Louis Pilla

If nurse leadership was difficult before the pandemic, COVID has brought with it its own challenges. Today’s top challenges nurse leaders face involve caring for staff’s emotional health and wellbeing; dealing with staff retention, furloughs, and layoffs; and coping with a traveling/ contingent workforce.

So say the October 2022 iteration results of the American Organization for Nursing Leadership (AONL) Foundation Longitudinal Nursing Leadership Insight Study. The results are the latest statistics from four studies conducted between July 2020 and August 2022.

In addition, the survey explored questions such as workplace bullying and violence, preparedness for a future pandemic, and nurse leaders leaving their roles.

AONL fielded the survey in August to nurse leaders at all levels across the care continuum. Most respondents worked in urban acute-care hospitals. According to the survey report, some 73% were either vice presidents, chief nursing officers/chief nursing executives, directors, or managers.

Specifically, 58% of respondents said emotional health and well-being were their greatest challenges; 56% pointed to staff retention, furloughs, and layoffs, and 36% indicated travelers/contingent workforce.

These findings were not a surprise but instead “were the validation of what we knew was happening in the healthcare environment,” says Simmy King, DNP, MS, MBA, RN-BC, NE-BC, FAAN, AONL treasurer and chief nursing informatics and education officer at Children’s National Hospital in Washington, DC.

Responding to Challenges

Nurse leaders said they had the most difficultly responding to financial resource availability and travelers/contingent workforce issues. Nurse leaders, notes King, have been “trying to find that fine balance between what financial resources we do have available to be able to operationalize and the increased costs of actual operations.”

King notes that helping a traveling or contingent workforce fully assimilate into a healthcare environment could pose challenges. “Realistically, you try to develop a good onboarding experience for them and resource them,” she says.

According to King, in some larger healthcare systems, “they have looked at more creative strategies like developing their own internal travel agency” where a nurse could move within the system. “It’s a creative way to look at different strategies to address the workforce challenges.”

Dealing with Bullying and Violence

On top of these challenges, nurse leaders in the AONL Foundation study said workplace violence and bullying were widespread. Some 83% of CNOs reported having witnessed workplace violence, and 72% reported having seen workplace bullying and incivility.

This workplace violence is “something that’s been top of mind for nurse leaders and healthcare systems for a long time,” says King. The past few years, she notes, have posed challenges for individuals, and “there’s a lot of trauma that we all need to heal from.” Healing will involve addressing the root causes of the trauma, and she notes, as well as “being very adamant about having no tolerance for those types of behavior.”

Working with the Emergency Nurses Association, AONL has issued guiding principles on mitigating workplace violence, and a toolkit, notes King. Those guiding principles include using evidence-based strategies to address all aspects of workplace violence; promoting a culture of safety; and creating a culture of nonviolence through intention, commitment, and collaboration from everyone in the organization.

Copyright: AONL Foundation Longitudinal Nursing Leadership Insight Study.

Future Pandemic

When asked whether their teams were better prepared for a future pandemic, the results were less than optimal. Since the initial July 2020 survey, the trend decreased by 20 percent, with 65% of respondents answering yes in August 2022 compared with 85% in July 2020.

“Right now, I think we’re facing the uncertainty of the future healthcare pipeline,” says King. Virtually all roles in healthcare, not just nursing, are facing shortages, she notes. “We have to see what we can do to ensure the consistency of being able to fill those roles in healthcare wholistically and not just singularly in one particular role,” she says.

Leaders Leaving

On a somewhat alarming note, some 13% of nurse leaders said they intended to leave their position within the next six months. Moreover, 25% said they are considering leaving, which “indicates organizational dissatisfaction on some level,” the survey report notes. Better work-life balance tops the list of reasons why leaders want to leave.

Drilling down into the data, some respondents were close to or considering retirement, notes King. But, in addition, “we do recognize the role itself is challenging, and they’re looking for opportunities to have more balance in their work, to have an opportunity to look at their work through a different lens,” says King.

To help nurse leaders, the AONL Nursing Leadership Workforce Compendium identifies best practices and innovations to support and empower them in attaining, retaining, and sustaining environments where they want to work and feel like they belong.

“Nurse leaders also need attention paid to their healing and their wellness in the same respect that they’re going to provide that in their leadership role for others,” says King.

Louis Pilla is a seasoned publishing expert with over 20 years of experience providing content and digital products to healthcare audiences.

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